“Unnecessary noise, then, is the most cruel absence of care which can be inflicted either on sick or well.”

By Florence Nightingale, 1859

NOISENOISEBy Ameya Nerurkar Mandar Samant

Chih-Pin Hsiao

Causes Of NoiseCauses Of Noise

In 1995, Guidelines for Community Noise from World Health Organization (WHO) recommends an Lmax of no more than 40 dB(A) at night measure on

the fast setting. They also suggest patient room Leq of no more than 35dB(A) during the day and 30 dB(A) at night.

 Study shows that the average day time sound levels in Johns Hopkins

Hospitals are 72 dB(A). 

Standards and Current ConditionsStandards and Current Conditions

The typical speech level for communication between two people is 45-50 dB(A) 

Effects Of NoiseEffects Of Noise- Several adverse effects are associated with noise

- increase noradrenalin concentrations in urine, hypertension and myocardial infarction

- Sleep disturbance

- exposure to sudden, unexpected noise raises patient heart rates

- tend to increase blood pressure levels

- In a hospital environment, where people are already ill and psychologically stressed, unnecessary noise can be very harmful

- Could cause staff stress and burnout

SolutionsSolutions

Assessing and managing Sound EnvironmentIdentify Sources of noise

Maintenance and replacement of Hospital equipments

Layout and acoustic treatment of patients’ rooms and corridors etc

Equipment Repair and ReplacementScheduling regular maintenance to keep equipments in working order

padding chart holders and pneumatic tube systems, and lowering volume levels on clinical and communication equipment

purchasing choices that are based on auditory performance

Design of Patient rooms and adjacent Areas:Standardize on single bed private room

SolutionsSolutions

Effects of Noise in ICUEffects of Noise in ICU

ResultsResults• Noise levels ranged between 49 and 89 dB (A) with

a mean of 65 dB (A). • Peak noise levels were measured as high as 89 dB

(A).• The noise levels measured at different locations in

the intensive care unit did not differ significantly.• Noises created by other patients, those who were

admitted from emergency room and operating room into intensive care unit, monitor alarms, conversations among staff were the most disturbing noise sources for patients.

ConclusionsConclusions

•  The patients who were located in the bed which was closer to the nurses' station were more affected by the intensive care unit noise than other patients.

• Having a previous intensive care unit experience also affected the patients' disturbance levels owing to noise.

• Relevance to clinical practice: Nurses are in key positions where they can identify

physical, psychological and social stressors that affect patients during their hospital stay. Staff education, planned nursing activities and proper design of intensive care unit may help combat this overlooked problem.

ICU Admission and Discharge ICU Admission and Discharge CriteriaCriteriaMengdie Hu, Karsten M. Jensen, Thomas Roh

ICU Admission and Transfer/Discharge GuidelinesICU Admission and Transfer/Discharge GuidelinesSt. Joseph Hospital 2009St. Joseph Hospital 2009

 • A list of criteria for the admission to ICU

 • Made to assure the appropriate utilization and resources of

the ICU 

Analysis of indications for early discharge from Analysis of indications for early discharge from the intensive care unit the intensive care unit Bone et al. 1993Bone et al. 1993

• Patients with moderately severe illness benefit more from ICUs than patients who are severely ill or not very ill.

• A predictive model can be developed to determine the mortality risk 24h after admission.

Consequences of discharges from intensive Consequences of discharges from intensive care at nightcare at nightGoldfred et al. 2000Goldfred et al. 2000

• Patients who are discharged at night have a much higher risk of dying

• Night discharges are more likely to be premature

• Insufficiency of intensive-care beds

Critically ill patients readmitted to intensive care Critically ill patients readmitted to intensive care units--lessons to learn?units--lessons to learn?Metnitz et al. 2003Metnitz et al. 2003

• Readmission raises the risk of dying more than four times

• Residual organ dysfunctions at time of discharge

• Optimizing organ functions in patients before discharge

Triaging patients to the ICU: a pilot study of Triaging patients to the ICU: a pilot study of factors influencing admission decisions and factors influencing admission decisions and patient outcomespatient outcomesGarrouste-Orgeas et al. 2003Garrouste-Orgeas et al. 2003

 • Patients triaged by a senior physician are more likely to be

refused admission • Refusal are related to patient age, underlying diseases, self-

sufficiency and number of beds available

The patient-at-risk team (PART): identifying The patient-at-risk team (PART): identifying and managing seriously ill ward patientsand managing seriously ill ward patientsGoldhill et al. 1999Goldhill et al. 1999

 • Patients admitted from hospital wards to ICU have a higher

mortality then patients admitted from other areas  • The PART protocol are a simple way of trying to identify

critically ill patients on wards

Analysis of indications for early discharge from Analysis of indications for early discharge from the intensive care unit.the intensive care unit.  Bone et. al 1993 Bone et. al 1993 

• Measures: Mortality and Quality of Life

• Acute Physiology and Chronic Health Evaluation (APACHE)

• Objective methods for determining patient discharge from ICU

  

Mortality among appropriately referred patients Mortality among appropriately referred patients refused admission to intensive-care unitsrefused admission to intensive-care units  Metcalfe et al. 1997 Metcalfe et al. 1997

   • UK - excess mortality for those too ill or too well

• 9% higher rate of mortality

• More ICU beds or better admission and discharge criteria

Guideline on Admission and Discharge for Adult Guideline on Admission and Discharge for Adult Intermediate Care UnitsIntermediate Care Units  American College of Critical Care MedicineAmerican College of Critical Care Medicineof the Society of Critical Care Medicine 1998of the Society of Critical Care Medicine 1998

• Admit low risk patients to intermediate care units

• List of Requirements

• Labor cost reduction

Discharge Criteria - A new trendDischarge Criteria - A new trend  Chung 1995 Chung 1995

• Discharging patients after anesthesia and surgery

• Mathematical scoring system for five different areas

• Recommends using a numerical system to determine discharging a patient